Field of the Invention
The present invention is generally directed to financial-bio-psycho social management models for optimal treatment of a chronic medical conditions, such as in one non-limiting instance being directed to achieving uncomplicated spinal pain management. More particularly, the present invention discloses a system, process and algorithmic based non-transitory computer writeable medium for incorporating best practices protocols into a multi-faceted module for treating a variety of medical conditions (including spinal pain management, heart disease, various types of cancers, etc.). Desired objectives of the system include each of adherence to best practices, patient functional outcome and patient satisfaction, the objective of which being to maximize economy of medical expense while recognizing and appropriately compensating medical providers for value received. In this way, the present invention attempts to improve upon the existing business model for medical care by incentivizing quality of care and resultant patient outcome, as opposed to basing compensation primarily upon the volume of care provided (such including test, medical procedures, etc.).
The present system seeks to revolutionize health care by implementing best care protocols, these established by the relevant payer or ACO (accountable care organization). The system provides financial incentivizes for the individual provider (e.g. MD or other professional) to adhere to the established protocols, this in large part dictated by the ACO establishing compensation in large part as a variable of the provider's adherence to the established best care protocols (as reflected in a given provider's score card), the effect of which being to improve the value of the physician patient relationship with better health outcomes achieved at lower cost. Additional advantages include providing clinical providers groups with clinical insight, leadership, education and training for management. The present system, method and software based algorithmic medium further serves to return the lost value to the patient/physician relationship.
Description of the Background Art
The prior art is documented with examples of systems and methods, such as utilized in the medical field. A first example of this is set forth in Moore, U.S. Pat. No. 7,693,727 which teaches interactive systems and methods for directing, integrating, documenting, and tracking steps taken by medical providers during the process of care for a patient's given condition. Doctors' actions are directed by a prescriptive protocol—a checklist of discrete steps designed for efficient or optimal care of an individual patient's specific condition. The step-by-step checklist is abstracted from decision tree guidelines for the optimal work up and treatment for the condition using probability-based methodology. The care protocols can be derived from widely available and non-proprietary guidelines and decision trees based on public medical research literature.
In one embodiment, the invention can be employed by a primary care clinician at the point of referral into the specialist sector, and at the specialist level when proposing a risky or expensive or otherwise problematic medical or surgical diagnostic or treatment intervention. At these two critical transaction points in care, the checklist functions like a lock, based on a hidden clinical decision algorithm (an explanation of which can be displayed upon request). The system asks the clinician for data and then generates the patient's optimal checklist, displaying it as a point and click form keyed to the stage of care being undertaken by each doctor. As the clinician enters data into the checklist, a decision engine determines whether the checklist data satisfies predetermined criteria for authorization of the proposed action. The system can also document each transaction taken in the process of care to create an electronic record that can be made accessible to all clinicians involved in the process of care.
Moore, US 2004/0044546 teaches interactive methods and systems for directing, integrating, documenting and tracking steps taken by medical providers during the process of care for a given patient's condition. Doctors' actions are directed by a prescriptive protocol—a checklist of discrete steps designed for efficient or optimal care of an individual patient's specific condition. The step-by-step checklist is abstracted from decision tree guidelines for the optimal work up and treatment for the condition using probability-based methodology. The care protocols can be derived from widely available and non-proprietary guidelines and decision trees based on public medical research literature.
In one embodiment, the invention can be employed by a primary care clinician at the point of referral into the specialist sector, and at the specialist level when proposing a risky or expensive or otherwise problematic medical or surgical diagnostic or treatment intervention. At these two critical transaction points in care, the checklist functions like a lock, based on a hidden clinical decision algorithm (an explanation of which can be displayed upon request). The system asks the clinician for data and then generates the patients optimal checklist, displaying it as a point and click form keyed to the stage of care being undertaken by each doctor. As the clinician enters data into the checklist, a decision engine determines whether the checklist data satisfies predetermined criteria for authorization of the proposed action. The system can also document each transaction taken in the process of care to create an electronic record that can be made accessible to all clinicians involved in the process of care.
A further example of the prior art is the healthcare providing organization (HPO) model of Cusimano-Reaston et al., U.S. Pat. No. 8,117,047, and which teaches a preferred provider network (PPO) or other membership agreement that allows individuals or groups to join via a membership contract. The contract allows the HPO to provide a technical component of a medical evaluation or service. Additionally, the HPO employs or retains the services of healthcare professionals who participate in and monitor an evaluation of a patient who can be at a remote location from the healthcare professional. The HPO provides a medical diagnostic unit, which is known as an EFA-2, that allows the healthcare professional to receive data that pertains to the patient via a real-time communication protocol, or the patient data is collected and stored on an electronic storage device. The healthcare professional then analyzes the patient data and issues recommended treatment.
Lee, US 2012/0109689 teaches a support system for improved quality healthcare, defined as MEGICS (Medical+Logistics), developed in order to improve quality of care and enhance the efficiency of operation of healthcare facilities and providers. When front-line healthcare doctors and nurses make various clinical decisions, MEGICS management system provides them with relevant clinical knowledge in a timely manner with the stated objective being to increase user satisfaction and provide better quality of healthcare services.
Gliklich, U.S. Pat. No. 8,489,412, teaches a data processing system for determining clinical outcomes of medical data gathered by the system. A doctor defines a medical study and can administer and collect data relevant to that study in real time from potentially geographically diverse doctors, patients and other people associated with the study. The system can analyze the medical data in real-time according to any number of clinical algorithms that may be custom defined and edited before and during the study. The clinical algorithms produce clinical outcome data that can be used for treatment of patients participating in the study immediately after the data is input and analyzed. The medical outcomes can indicate such things as performance comparisons, composite outcomes, and risk stratification and assessments for such things as treatments, drugs, illnesses, doctors, patients and physicians groups.
In summary, and while describing various systems, methods and protocols for attempting to optimize the efficiency of patient care, the prior art as a generalization acknowledges the inviolability of the present healthcare delivery model with its existing compensation and incentive structures. These notably reward physicians and other medical providers based on the quantum of care provided (e.g. tests conducted, surgical procedures performed, etc.) and as opposed to tying such compensation/incentives to documentable patient outcomes.